Critical Comment Review

Science and Technology Committee Oral evidence: UK Science, Research and Technology Capability and Influence in Global Disease Outbreaks, HC 136”

Monday 9 November 2020

Details of the Session

Produced by

@PoliticsAired

Intent

To review the evidence presented by Prof Whitty and Sir Patrick Valance to the Science & Technology Select Committee, on 3 Nov, and highlight each of the points at which they it is demonstrated that there is a low [or no] confidence about the effect of certain measures, eg the closure of religious buildings. Additionally, to highlight any other relevant evidence, for example where Prof Whitty failed to answer a question about false positives in PCR tests.

Format

Q####The Question numbers are Referenced to the original question, and if clicked will jump to that point in the original transcript (lower portion of this document). The main paragraph body will be commentary about the specific question or answer. Some “quotes will be included in paragraph text”, whereas there will also be:

“Direct and important quote from a Member or Witness, as per the original transcript.”

Further commentary about the question, answer, or quote will be present in any subsequent paragraph.

A copy of the original transcript was saved alongside this document and it is recommended, where possible, to have that file to open in parallel as a reference so as not to constantly jump away from this commentary.

Review & Commentary

Q1433Vallance starts with “It is very difficult to put numbers on an exact peak”; he then mentions that “the R# is above 1 everywhere”. This was known to be [at best] only marginally true. The ZOE/CSS/KCL data was already showing that the R# was dropping towards, if not at 1.0 in many areas already. This fact was published on 4 Nov (link to 4 Nov file) (link to latest report). Prof Whitty does address the ‘multiple data sources of R# later on.

“You would expect the number of deaths, potentially, to equal the first-wave numbers somewhere in mid-December. That is what they would look like. That is the range you think of in the trajectory if nothing changed from where it was now.”

This is patently absurd, as to assume that 1st wave levels can be reached discounts all Herd Immunity (antibody, T & B cell) and neglects the difference between a Pandemic Gompertz Curve event and a seasonal increase in an Endemic virus. The basic ‘Herd Immunity’ deaths based on an Infection Fatality Rate (IFR) of 0.5% would be c 80,000, so to postulate that more deaths would be seen in ‘wave 2’ than ‘wave 1’ ignores the 42,000 deaths of ‘wave 1’ as well as the demonstrably endemic seasonal nature of ‘wave 2’.

Q1434No comment

Q1435Vallance opens with:

“I said that those were scenarios that were put together to try to look at what a new, reasonable worst-case scenario might look like. They are from a couple of weeks ago. They are longer-term modelling, which come with all the caveats in terms of accuracy.”

1 – In Q1433 Prof Valance said “the six-week forward projection, that is the part of the modelling where you are going to get greatest reliability” but admits to using graphs that project into March 2021.

2 – The models are based on pandemic, not endemic assumptions.

3 – They are based on R#s that were already inaccurate, and (as was quickly shown) already proven completely false as they required a higher death count that was seen on ehte day of publishing.

Vallance states that the graphs are used to create a “reasonable worst-case scenario” yet another chart (as published by the BBC shows that the SAGE ‘reasonable worst-case scenario’ bore no resemblance to any of the models’ curves; suggestive that the high casualty models were merely a scare tactic.

Q1436Summary – the ‘scary graph’ (Slide 3) was not a consensus view and SAGE did not use it to brief the Civil Contingencies Secretariat, as they only want the ‘reasonable’ six-week forecast; so by showing it, Vallance/Whitty were doing nothing helpful at all, and merely scaring the public into compliance.

It should also be noted that at no point during the public briefings, or at any other time, has a prediction/model of the effectiveness of a restriction/lockdown been shown, or any projection of what ‘success’ might look like. Throughout, no metric against which the public might be able to judge the success of their hard work and sacrifice has ever been offered.

Q1437No comment

Q1438Vallance states that “some hospitals are clearly under pressure now…”, whereas the numbers show that this is no worse than average for this time of year.

Prof Whitty opens with

“It is important to say that a lot of the advice that I have given is not based on significant forward modelling. It is based on what has happened and what is observable

This is important as he makes similar comments throughout; he is clearly unhappy with the ‘long range’ projections of Vallance and tries to distance himself from them.

Prof Whitty states that “You do not need too much modelling to tell you that you are on an exponential upward curve of beds.” Unfortunately, at no point is the explanation of why any modelled ‘exponential curve’ starts to drop offered for consideration. All SAGE hypothesis seem to be on pandemic curves and not the more gradual S-shaped seasonal curve that would reasonably be expected.

Q1439When questioned about peak beds in the NHS, Prof Whitty answered:

“There is some evidence of some slowing, particularly in the north-east and possibly in the north-west, that might push that out in time, but until you start to see rates falling - it is a matter of timing as to which week you get into for these various stages - and they do not happen all at once or all at the same rate throughout the country…”

This demonstrates that SAGE was aware of the falling rates but was not prepared to watch and wait to see the effects of current Restrictions or natural levelling-out of the viral curve.

Q1440No comment

Q1441No comment

Q1442No comment

Q1443No comment

Q1444Vallance states “…we cannot deal with NHS capacity. I do not have insight into NHS capacity.” This seems ridiculous given that he’s sitting next to the CMO and that the ‘we’ in his sentence is SAGE, that does have insight into NHS capacity.

Q1445When asked about the projected overloading of the NHS, which was the fundamental basis of this Lockdown and presented to the PM in a way that he could not gainsay, Prof Whitty stated that:

“It is a serious risk but is not inevitable. The actions being taken by people are already having an effect. Our view is that it is just a matter of time. Once the R is above 1, it will keep on going up and the question is only how long.”

This is contradictory. If the measures are having an effect and the R# has dropped from 1.3-1.5 down to 1.1-1.3 (as briefed), and we know that its trend is downwards, then the question is not one of ‘how long’ but one of ‘if at all’.

Q1446Prof Whitty states that the effect of the Tiered restrictions “will not yet be feeding through”, yet he has just admitted that the R# is dropping, so to suggest that the R# will stay above one suggests either that he has no faith in the Tiered restrictions - which he later states that he does – so the question must be ‘why would the R# stay above one’? Might this whole thing be a petulant ‘we told you to listen to us’ dig at the PM by SAGE?

Prof Whitty continues to say “but it [the R#] is still, as far as we can tell, going up, albeit at a much, much lower rate…”. This is wrong, in fact it had dropped across the entire country from two-weeks previous.

“What you are indicating, and rightly, is that putting exact dates on these things is almost impossible.”

Q1447No comment

Q1448Vallance waffles but tries to say: ‘we have included data in these six-week models from the lessons learnt from the implementation of the Tiers but only to the degree to which their effects can be known.’

Q1449No comment

Q1450No comment

Q1451When asked about the effect of the Tiered restrictions, Prof Whitty:

“It is difficult to be absolutely confident about how far their effect has gone. I am confident that tier 2 has had an effect and that tier 3 has had a bigger effect.”

But he then immediately states this:

“…[the regions in Tier 2] have responded remarkably to this. Because of that, I am confident that the rates are substantially lower than they would have been had those activities not happened.”

Which is contradictory to Vallance’s waffle that suggested that the impact hadn’t really filtered through yet and that is why the impact of the Tiered restrictions wasn’t fully embedded into the current forecasts. He then states that they have to act quickly with a new Lockdown because:

“…there is quite a long lead time between taking an action and having an effect…”

In Q1433, Vallance stated that…

“What we can see, though, is that the R remains above 1 everywhere.”

But here in Q1451, Prof Whitty states that…

“We do not, in my view, have clear evidence at this point that R is below 1 anywhere with significantly high rates.

This insinuates that the R# is below 1.0 in areas where Covid rates are not ‘significantly high’. This demonstrates that either SAGE is not fully aware of the R# across the country, or they are being economical with the truth when answering different questions.

Q1452Prof Whitty mentions the case numbers being different in different age groups. This data might be available on the Gov.UK site and would be worth analysing to see how severe the differences are. Prof Whitty suggests that the case numbers on the elderly are more concerning as they translate into more NHS cases. This is strongly supportive of a GB Declaration type strategy and not the ‘one size fits all’ strategy that is currently being implemented.

Q1453No comment

Q1454No comment

Q1455Chairman asks if the data behind the above comments on ages will be published. Prof Whitty says that it’s not his to publish, that it is JBC’s data but that he sees no reason not to publish it, suggesting that age data isn’t in the public domain – why?

Q1456No comment

Q1457Prof Whitty “I am very strongly in favour of people seeing the data”

Q1458Prof Whitty:

“At this point in time, all around England, R is either above 1 or tending towards 1 but not falling at this point overall.”

How can something be ‘tending towards 1’ (from above 1) but not be falling? Also, ‘overall’ it was absolutely falling as demonstrated by ZOEE et al. Again, he contradicts his earlier suggestion that R# might be below one in some parts of the UK.

Q1459No comment

Q1460Talking about Slide 3, Vallance says:

“…those figures, therefore, were not as reliable as the six-week figure, which I spent time talking about. Those figures were done by major academic groups based on those assumptions.”

Vallance trying to distance himself from models that he used in a briefing to the public.

Q1461When asked about the ‘reasonableness’ of presenting 4,000 deaths a day, Vallance said:

“They were modelled at the time to try to project that. They came from significant academic groups. They are no more than a model of the reasonable worst-case scenario based upon assumptions. The further the models go out, the more unreliable the numbers are and the more it becomes a qualitative exercise to look at the shape of things.”

But he didn’t (in the briefing) state how old the data were, or the assumptions used, nor was there any explanation as to the means by which the ‘peak’ was generated, or why these curves had such vastly different maximums.

He mentions in his testimony that as uncertainty rises, the ‘shape of things’ is important, yet in October SAGE had already warned (around the time of the Tiered restrictions) that we would see a lower but longer winter infection rate. See graph in above comment on Q1435; if the black line is of a ‘reasonable worst-case’ scenario, and this line was drafted by SAGE before the briefing (BBC, Daily Telegraph and Daily Mail all published similar ‘long but low’ graphs before the briefing, see Q1477), surely all the other lines are ‘unreasonable’ scenarios.

Q1462When asked if he unreasonable scared people, Vallance said:

“In a sense, we went through this a bit on 20 or 21 September when we said that we thought things could be headed towards 50,000 cases per day if we had a doubling - again, it was a scenario, not a prediction…”

“As it happened, the numbers turned out to be very close to that by the time we got there.”

What poppycock! The numbers never got anywhere close to the ‘50,000 cases a day’, only peaking at 18,900 cases on 13 Oct. He raises this lie again latter. There is a disturbing level of hubris in the evidence presented and a scary belief that they are materially affecting the trajectory of a viral pathogen.

Q1463 No comment

Q1464A question on why the ‘other side of the ledger’ is not presented during briefings. The answer is ‘it’s not our job to look at that’ but clearly it is as they are the Scientific Advisory Group for Emergencies and as such must also understand the negative consequences of their recommendations.

Q1465Prof Whitty: The ‘four types of deaths’:

1 – Direct Covid deaths,

2 – Deaths from NHS emergency capacity being overwhelmed,

3 – Deaths from NHS elective capacity being overwhelmed,

(…then you have the benefits of air quality and the damage of poor Mental Health)

4 – The economic effects.

Prof Whitty claims that the Cancer deaths etc are (somehow) on the Covid side of the ledger. He also seems to suggest that the Mental Health issues are included in point 3 as well, but his phraseology was difficult to be certain about.

Apparently 1, 2, and 3 are all ‘Covid deaths’ but no comment was made about the huge cost to life that Covid has made even when the NHS has been far from stretched all summer yet cancelled thousands of treatments and appointments. Cancer diagnosis is merely one element of this. ‘Lockdown’ is constantly sold as a ‘means to save the NHS’ but no explanation is given as to why the NHS has not been operating a full service for months.

Clearly SAGE feel that Covid is responsible for a lot more than just direct Covid deaths, even though these wouldn’t have occurred if a better approach had been adopted.

Q1466Vallance on the integration of medical issues with broader negative medical and socio-economic issues. He seems to think that Covid-medical issues are in the realm of SAGE but any negative medical outcomes are not in the realm of SAGE.

“It needs to come together with the economic analysis. That is not something that takes place in SAGE, nor should it take place in SAGE. It needs to come together in the Cabinet Office.”

Q1467No comment

Q1468No comment

Q1469According to Vallance the ‘reasonable worst-case scenario’ that they used in their briefing is not SAGE’s to publish and belongs to the Civil Contingency Secretariat.

Q1470No comment

Q1471Vallance states that the models in Slide 3 were from “independent groups and what they have modelled” but offer no contrition that the models were produced [it is suggested] at the bequest of SAGE.

Q1472Vallance: “The assumptions underlying the models will be published in full” but they weren’t published at the time, which seems irresponsible.

Q1473No comment

Q1474They were asked why they presented models to the PM that included predictions that were already demonstrably false in that they required death levels far higher than reality. The witness both waffled about ‘Monday deaths being low’ and then deflect the question without addressing the underlying point – very disingenuous.

“What you see is the initial portion of those curves for the other projections are there or thereabouts for two of them and higher than the real data for two of them. Ultimately, of course, data trumps models.”

If it is the case that two of models were known to be demonstrably false, why would they be presented to the PM, let alone the British public?

Q1475When asked if the graphs were discredited, Vallance said:

“I do not think it is at all fair to say it is discredited. These are scenarios put together on assumptions to look at what a reasonable worst-case scenario might be. As Chris has said, you do not want a reasonable worst-case scenario to happen, but it could plausibly happen if things went in a certain direction.”

Although ‘discredited’ may be unfair, any scientific model that is proven false must be deleted from all consideration, yet they were presented as plausible. Vallance goes on to talk about things that might ‘plausibly happen’, but these cannot ‘plausibly happen’ as they are already adrift from reality.

Vallance then says to look at the six-week projections, but these all show an upward curve, when it was already known and accepted at the time that the trend was downward, or at least plateauing. Prof Whitty offers:

“…but reaching the peak we reached in April strikes me as an entirely realistic situation.”

No reasonable understanding of the difference between epidemic and endemic/seasonal curves would suggest that an April peak in hospitalisations is remotely plausible.

Additionally, if one is to accept that ‘wave 1’ hospitalisations and deaths were disproportionately in the elderly, then any ‘similar’ peak in cases during ‘wave 2’ cannot result in the same number of hospitalisations or deaths as it would (presumably) be of a more representative demographic.

Q1476Prof Whitty:

“All I am saying in response to this question is that there has been some rather overblown rhetoric. People can take different projections if they wish but getting to the stage we got to in April and, if we do nothing, carrying on up from there is entirely realistic.”

The ‘overblown rhetoric’ was surely that presented by Whitty, Vallance and the PM.

Q1477Prof Whitty:

“Given this is an exponential curve, the idea that this could go from the mid-200s to the 1,000 mark over a number of weeks does not strike me as a particularly strong thing to be saying.”

There is no explanation offered as to why the ‘exponential curve’ would continue to rise, or at what point it would level off. The continued threat of ‘exponential growth’ is never tempered by a commentary explaining that these numbers taper off for all viruses on a seasonal basis. Before the 31 Oct briefing, the Daily Telegraph, BBC and Daily Mail all reported that SAGE was predicting a lower peak but extended throughout the winter. On all graphs the upward trend is abruptly stopped – similar to that which is expected for a seasonal spread but not an epidemic spread.

Q1478No comment

Q1479No comment

Q1480When asked why there is a significant difference between the Slide 3 models and the six-week projections, Vallance said:

“If this is confusing, I apologise, but I was clear that the model projections for six weeks were the things on which one needed to concentrate. Those are the things about which you can have more reliability in terms of the numbers. The others were scenarios for reasonable worst-case planning, making an assumption about what the R would be and that it may increase over the winter.”

Q1481Interesting question: when informed that David Spiegelhalter was unimpressed by Slide 3, Vallance again tried to distance himself from his own graph by saying:

“I would reiterate that the two graphs that are important are the six-week projection ones.”

Whereas Prof Whitty interjected with the statement that:

“Can I be clear that for that reason I have never used anything beyond six weeks in anything I have ever said to any Minister on this issue?”

This latter point opened up an interesting split between Vallance and Whitty.

Q1482Jeremey Hunt explored the possibility that Prof Whitty (and maybe SAGE) didn’t present this to the PM but did present it to the public. Valance confirmed that it has been presented to the PM…

Q1483Jeremy Hunt questioned if the PM had seen the graph, Vallance said Yes. This highlights a split between Valance and Prof Whitty, with Whitty clearly trying to put further distance between him and Slide 3.

Q1484A set of questions around the measurement and effectiveness of Test & Trace.

Q1485No comment

Q1486No comment

Q1487Prof Whitty on whether Test & Trace will work better with a lower number of Covid cases:

“Even under optimal conditions it will do a lot better with much lower incidence. All other things being equal - that is a big “if” - it will probably be having a bigger effect now, if anything in the areas which have slightly lower incidence than higher incidence areas. That is what most modelling in this area would imply.”

“…even under perfect conditions, test and trace takes only a proportion of the R. It is not that you do that and forget everything else; it is a proportion. That is all we can reasonably expect of it.”

Q1488Chairman: “What assessments have you made in your models of the contribution that test and trace is making?”, Vallance:

“I cannot give you the exact proportion; it varies from model to model and what view people take on that.”

Q1489Vallance continues:

“I think there is a paper from June which looked at the question of the impact and effectiveness of different levels of Test and Trace on the overall ability to control R, and what other measures you would have to have in place depending on that. The papers lays that out.”

Q1490Chairman: “…have you assumed that test and trace is going to make an impact on transmission over the next six weeks?”, Vallance:

“I cannot tell you exactly what is in each of the models, but it will not be an assumption that there is a big impact from Test and Trace at current levels of prevalence.”

Basically Test & Trace is a £12 billion waste of money.

Q1491Dawn Butler now asks a number of questions to no-one’s benefit.

Q1492No comment

Q1493No Comment

Q1494 No comment

Q1495Dawn Butler: “Did the shielding of vulnerable people help to save lives?”, Prof Whitty:

“We have not had a really clear answer. There were definite benefits and disbenefits of shielding. The benefits were reducing the risk that people got Covid. The trouble with that is that it was not a denominator because you took all the people who were at risk into the shielding group.

“The downsides to it were also clear: an increase in loneliness and, in some cases, probably mental health issues and so on. In trying to work out the balance between those, our impressionistic view is that shielding was useful but there should be a less strict version of shielding in the next phase to allow people a little bit more time outdoors particularly and so on.”

“The view is that the risk is not sufficient to justify the significant downsides, but there have been other important changes with the shielding, so you have asked an important question.’

That fact that shielding occurred goes to demonstrate quite clearly that Matt Hancock’s protestation that ‘it’s impossible to shield the vulnerable’ for the purposes of the GB Declaration is not backed up by historic fact.

Q1496Chris Clarkson: “At what rate have you accounted for [PCR] false positives and false negatives in your modelling, and what are those rates?”, Vallance states that false negatives are virtually none because…

“…one of the reasons it picks up people who are not actually infectious but those with residual RNA from having a virus.”

Vallance completely omits to answering or addressing the false positive question. Prof Whitty interjects with:

“…so the risk of a false positive is higher when the rates are lower.”

While true, in that the large number of false positives is more damaging at low prevalence but is masked by actual positives at higher prevalence, he absolutely fails to offer any percentage value. A very useful paper on the dangers of the UK’s bad PCR testing structure is in the Lancet here.

Q1497Chris Clarkson clearly doesn’t understand the nature of false positives and negatives.

Q1498No comment

Q1499No comment

Q1500No comment

Q1501 No comment

Q1502Vallance corrects a previous comment with “Chris and I have said many times that we think very carefully about the health impact of lockdown and other measures. We are very aware there are impacts…”

Q1503Vallance:

“We do not [look at the economic impacts of our proposals]. That is not the role of SAGE. We have been very clearly instructed that the economic impact of this sits in HMT. HMT looks at the economic impact. Therefore, we do not look at the economic impacts and we are not mandated to.”

This is a gross dereliction of duty, as Prof Whitty and Vallance have previously admitted that economic impacts are causally linked to health outcomes, so to not fully appreciate the downstream health impacts is disastrous. Prof Whitty:

“These are very difficult decisions. We have no illusions that there are health disbenefits to the economic things; there are massive economic disbenefits. None of us is under any illusions. This is really problematic. We are choosing between bad choices. None of us should shy away from that and pretend that is not the case.”

To not fully account for the negatives in a review of outcomes is to justify suggestions such as ‘We propose that everyone stops beathing to prevent the inhalation of pollution’.

Q1504No comment

Q1505The question regards whether a Circuit Breaker in Sep would have been a good idea. Vallance says:

“…the intention of driving the numbers back to how they were in August, going back to the discussion on Test and Trace, because that means you have a greater chance of Test and Trace being effective. That takes more of the load in managing the disease and you may have to do fewer in terms of other non-pharmaceutical interventions…”

At best a Circuit Breaker would have ‘reset the cases by a few weeks, back to the steady-state numbers in late Aug’. Thereafter the numbers would rise again in-line with normal seasonal viruses. It’s hard to believe that the Test & Trace system would have fared any better with this marginally smaller number of cases.

Q1506No comment

Q1507No comment

Q1508Asked what they feel about the ZOE/CSS/KCL view that R# is at ≈1.0

“We get different estimates of R from different places. You will know that the REACT study from Imperial from the end of October suggested that the R was 1.6 across the UK. …we will expect a new updated R from the SPI M group which will be published on Friday and see where that is.”

Why they are still receiving anything from Imperial College London should be baffling to anyone who has read its constantly wildly over-estimated numbers. Incredibly unhelpful that the next consolidated estimate was after the Parliamentary vote. While the source data does not seem readily available, newspapers have reported that the R-number SPI-M estimated on Fri 6 Nov was still in the range of 1.1 – 1.4.

Q1509Aaron Bell asked why were graphs (Slide 3) that were shown to the public used an R# of 1.3 – 1.5 when it was known that he R# was already down to 1.1 – 1.3? Vallances stated

“It was an assumption in that one graph; it was not in the six-week projections. The reasonable worst-case scenario is based on an assumption of an R between 1.3 and 1.5 getting potentially 10% worse over winter.

Q1510This question mentions a ‘reasonable worse-case scenario’ leaked to and published by The Spectator on 30 July. This is the referenced graph, and original article.

Q1511No comment

Q1512While discussing the above graph and why the plateau exists, Vallance stated:

“One of the challenges is to come up with a scenario that is both reasonable and worst case. I think that was exceeded in terms of the speed of the upswing. We still do not know what shape this is going to be.”

Q1513When pushed about the shape of the graph, Prof Whitty said:

“None of us has been through this virus at this time of year, so how can we know exactly in advance exactly what different things will do? Let us be a little bit cautious about our own ability to predict.”

Q1514Aaron Bell asked why 1,442 hospitalisations could be perceived as ‘above a reasonable worst-case scenario’ if that scenario had predicted hospitalisations to be at 3,000. Vallance waffled and bluffed an avoidance answer then went on to talk about the nature of forecasting:

“…as you look at the longer-term projections the numbers are almost bound to be wrong in one direction or another. As you look at shorter time periods you can have much more confidence in that. In the next two weeks you can have some degree of confidence that you will probably be there, or thereabouts. Over six weeks they have performed reasonably well. When you go beyond that you start to have uncertainty. That is when you have to rely on data and it is a changing baseline,…”

He went on the say:

“That has been important in getting the R, which would naturally want to be at about 3, to somewhere between 1.1 and 1.3 at the moment.

This is odd as the WHO estimate of Covids’ R0 is 2.5, maybe as high as 2.63, but no sensible estimate of the Covid R0 has been anywhere near 3.0 since the spring; BMJ, May 2020. This suggests that the SAGE baselining of R0 is rather high (pessimistic).

Q1515Aaron Bell made the point that the Hospital numbers presented were not representative of the true picture of the NHS, and made the situation look worse than it really was. The slide was another example of fearmongering. Prof Whitty said:

“What I said and what was on the slide - in my view, having seen it replayed, it was not an ideal slide from the point of view of it being seen it on the TV - was that those were just hospitals which at this point in time had 100 Covid cases or more.”

Q1516No comment

Q1517Prof Whitty said:

“Across the board, my reflection is that the great majority of people - and this is reflected in all the polling and a variety of other things - both intend to stick to the rules and do stick to the rules to a remarkable degree.”

The evidence on isolation post a T&T notification to do so would contradict this point. Though he did comment earlier that while some people may break a rule here or there, and be marked down as ‘not complying’, they are generally complying, which achieves much of the effect. If he feels this is so, why do we need laws instead of simple and sound guidance? Vallance said:

“First, you are absolutely right to raise the point that these interventions do work. It is not that they don’t work. They have an effect, and you can see that in terms of the R having come down a bit. There is no doubt they work,…”

There is very little direct evidence that any Government intervention has materially affected the R-number in any way. The peak of cases in Mar was before Lockdown, Masks have no evidence to support their effectiveness and the data around the pre-Tier northern lockdowns is disastrous; The Spectator produced this (source @ 00:29:00).

Q1518No comment

Q1519An interesting little dialogue about exiting Lockdown on 2 Dec. The Chairman asked: “do you expect us to be able to lift these restrictions on 2 December?” to which Prof Whitty replied, “The Prime Minister has stated that that is what he intends to do.” The Chairman picked up on this evasiveness and went on…

Q1520The Chairman asked that given modelling of the restrictions must have been made, does the modelling suggest that by 2 Dec enough will have been done to lift the restrictions. Prof Whitty was evasive once again and stated that:

“The decision as to whether to lift the restrictions on 2 December is not a modelling decision. It is, rightly, a decision for Ministers and Parliament…”

Q1521The Chairman pressed the point that SAGE must have modelled these measured and formed a prediction as to whether they would be successful in dropping cases to a level which would be sufficient to see the Lockdown lifted on 2 Dec, so he asked again:

“If we adopt these measures and vote for them, will they succeed? According to your best ability to forecast this, do you think they have a good chance, a reliable chance, of succeeding to the point that they can begin to be lifted on 2 December?”

To which Prof Whitty was evasive for a third time and stated:

“The aim of this is to get the rates down far enough that it is a realistic possibility to move into a different state of play at that point in time.”

At which point the Chairman sadly gave up pushing the point. It raised an interesting point: that while ‘reasonable worst-case scenarios’ have often been briefed to scare the public into submission, never has a prediction of the outcome of a restriction, lockdown, or other measure ever been presented, against which the public might be able to judge its success or failure. Without these predictions, how can anyone judge the efficaciousness of any measure, restriction, or lockdown.

Q1522No comment

Q1523No comment

Q1524When asked “Have we learned no lessons since March?”, Vallance stated:

“Just to be clear, what I said on the 21st was very clearly not a prediction. It was a model saying, if it doubles, this is what it could look like. It turns out that it does look like what we said, not because it doubled but because it started from a higher baseline, but those numbers turned out to be just about exactly where we ended up in October.”

The data that SAGE are reviewing is clearly not the same as that which the rest of the country has access to. There is a dangerous level of hubris on display during this session by both Prof Whitty and Vallance; they show an honestly held but grossly misguided view that their actions are materially impacting the transmission of a disease.

Q1525Carol Monaghan’s questions were all very much along the line of “how bad is the English Government?”

Q1526No comment

Q1527No comment

Q1528A question on schooling. Prof Whitty:

“On balance of risk for children, that balance in our view, professionally, is firmly for children to be at school.”

On the risk to teachers:

“As to the risks internationally, although the data are not absolutely overwhelming, all the data, including ONS data, do not imply that teachers are a high-risk occupation… …If you look at the ONS rates, they look almost identical to the communities from which they are drawn…”

On the effect to R#

“Here, we have quite a lot of consensus that the transmission in primary school children probably is a relatively small contribution… … but the reality is, in our view, that the benefits to children are really clear.”

Q1529A question on Universities staying open.

Q1530No comment

Q1531Mark Logan: “What advice does SAGE give to Government in making decisions where evidence is weak - for example, on the closing of places of worship?” Vallance said:

“You are right: we do not have good evidence on the exact value of each intervention on R. We produced a paper suggesting what that might be in different areas but said that this is not a very exact science at all. Therefore, I am afraid it is a rather blunt instrument, and it is about making sure that there is a package of measures that, together, has a chance of getting R below 1.”

Q1532“…how much transmission do you think has taken place within places of worship?” Vallance:

“I do not think we have good data to answer that with any degree of certainty.”

Prof Whitty added:

“One additional thing is that there is some very weak data to imply that, even if the place of worship has been incredibly good about being Covid secure, by bringing people together, people can congregate outside and do things that lead to transmissions, but this is very variable. A lot of this is anecdotal, so we should be a little careful about putting that out as a scientific fact.”

Q1533No comment

Q1534Mark Logan goes on: “When I look at the SAGE advice from the NPI paper of 21 September, it does not make a hugely convincing argument about the R rate in relation to places of worship.” Prof Whitty:

“We are trying to avoid a situation where we are constantly double-guessing at a micro level what individual Government decisions are.”

Q1535The Chairman brings the conversation toward exercise.

Q1536Chairman: “are you aware of any instance in which a Covid infection has taken place between children playing football out of doors?” Vallance:

“Not that I am aware of, but there may be evidence; I have not seen it.”

Q1537Chairman:

“Given what Professor Whitty said about the benefits of exercise, it is the case that children’s sports teams outside school settings are now not allowed to meet. This seems perverse given the importance of exercise, and, as you have told this Committee before, the very low incidence outdoors of transmission… Is it something that you could further advise the Government on, because there is a lot of concern among children’s sports teams across the country?

Vallance:

“We have been very clear as to where we think the areas of transmission are most likely to be. We have also been very clear that an entire package that takes into account everything including interactions around events becomes quite important. It is not just the event itself but what happens in and around it, and it is then for policy makers to decide what policies they want to adopt on the basis of that.

Q1538Chairman: “Would you advise that children’s outdoor sports should banned?” Vallance:

“As Chris said, we just do not go down to that level of individual activities.”

Q1539Chairman: “So who does?… Who is advising the Government on this? Who is telling the Government what to do?”, Prof Whitty:

“Our job is to give the broad advice and then leave it to those who have to integrate the various elements.”

Q1540Chairman (paraphrased): How can we represent our constituents and scrutinise a package that is pre-packaged? SAGE has advised… that, for outdoor gatherings in general… the reduction in R is likely to be less than 0.05%. Is this not something that… needs to be looked at again? Prof Whitty replied:

“If Patrick and I end up trying to unpick quite complicated packages that have been put together, in that way disaster lies for everybody. We have to give broad principles, which we have done… They are published in SAGE minutes. Packages then have to be put together… Everybody who is doing this is balancing really difficult things and it is not our job to make their lives even more difficult…”

Q1541Chairman: “How can MPs… influence this if we can only scrutinise things that are too late to do anything about?”, Prof Whitty:

“I suggest the people to scrutinise are those who have to put together these very complicated packages.”

Q1542A long question on the metrics used to judge success and to monitor the future so the R doesn’t rise again. Lord Patel is asking about the metrics used to judge ‘success’:

“I would like to understand what your thinking is in terms of the metrics that you will use to assess the effectiveness of the measures we are about to go into…”

Whereas Vallance is evasive and answers about the metrics used to judge the general progression of the virus and specifically offers no insight into the metrics used to quantify the success of the Lockdown based against any model of its perceived effectiveness.

“…with things like the ONS survey, the REACT survey, the ability to measure infections in the community, and all the work JBC is doing. We should absolutely look at infection rates. That is the way we are going to find out earliest what the effect is. Contact rates may give you more information even earlier. For infection rates, hospital admissions will be a slightly lagging indicator. Unfortunately, there will be deaths, and they will be an even more lagging indicator.”

Q1543Prof Whitty agreed.

Q1544A question on how Christmas will affect the R# and what can be allowed to happen. Prof Whitty:

“We will have to work out ways in which we can advise people in a way that maximises their ability to keep to the essence of what the festivity is but minimises the risk of transmission.”

Q1545Beginning of a long series of ‘what if R is above 1.0 questions and evasive answers. Chairman asks: “If we get to 2 December and R is greater than 1, does that mean that we cannot come out?”. Prof Whitty:

“The aim of the whole thing is to make sure that R is not greater than 1.”

Q1546Chairman: “But if we get to 2 December and R is greater than 1, does that mean that we cannot come out?”. Prof Whitty being evasive again:

“I do think it is sensible to see how we go on this… People intend to do this and I am expecting that the R will drop.”

Q1547Chairman: “You expect by 2 December the R to be less than 1?” Prof Whitty:

“Yes. Nothing is certain in this world. It may not be absolutely everywhere, but… as a whole that is what I would hope to happen.”

Q1548Chairman: “If the R was very slightly above 1… would it be possible to contemplate that the infection could still be spreading, albeit at a rate that we could contain comfortably within the capacity of the NHS?”. Prof Whitty:

“The problem we have here… is that we have almost infinite future scenarios as to what this could look like come the end of this month. Rather than try to speculate on almost infinite numbers of them [and even]… Before we have even had Parliament vote on these, speculating where we will be in three to four weeks’ time is a little premature in terms of exactly the kinds of questions you are asking about what plans should happen next.

Q1549Chairman: “…the support of many MPs may be contingent on having an idea as to how they will be lifted and whether, if… the R is still technically above 1, that will be a veto.”. Prof Whitty:

“The decision as to the strategic goal is rightly a decision for Ministers… You could have a scenario where R is just below 1 but there is an incredibly high rate and a very struggling NHS in one area, and in another area R is above 1 but the NHS is a long way away from difficulties. I am not saying this will happen; it is just a theoretical possibility. Those kinds of scenarios would lead to different responses from Ministers at that point in time, and reasonably so.”

Q1550Chairman: “Are you aware of what the strategic goal of the Government is?”. Prof Whitty:

“The strategic goal of the Government is primarily to reduce mortality, but they have much wider strategic goals, including protecting the economy and society.”

Q1551A question on the effectiveness of Test & Trace and if it would be better if localised.

Q1552A follow-on question on the same but an interesting comment from Prof Whitty about data:

“One of the things that Sir Patrick has made a real push on - and I completely agree with this - is that not just the NHS but the whole system needs data to flow more fully in every direction. That is in everybody’s interest so that everybody sees as much information as possible. This is important scientifically, operationally and for public health.”

Q1553A question around: ‘If we had more NHS ICU beds, would our response had been able to be less severe?’. Vallance:

“…yes, it must be the case that, with a larger healthcare system, you would have more headroom to avoid collapse of the system or get close to real pressures.”

Which raises the question as to why the Government didn’t spend the entire summer building emergency NHS capacity. If a lack of beds was the fundamental justification for the removal of our liberty, why then would the Government not address this singular issue.

Q1554No comment

Q1555No comment

Q1556Would a Tiered system in Dec push the R# back above 1? Prof Whitty:

“That very much depends on the situation in which we find ourselves and what takes its place, and those are two imponderables.”

Q1557A follow on question that raises an interesting point on possible future policy. Prof Whitty:

“The Prime Minister would probably want us to look at where there should be variations on exactly the same tiering system as at the moment rather than just assuming we would revert to an absolutely identical one.”

Q1558No comment

Q1559No comment

Q1560No comment

Q1561No comment

Q1562A question on the Great Barrington Declaration. Chairman: “Do you model the prospective impact of different approaches, or is your work on SAGE exclusively focused on the lockdown and social distancing measures that we have been talking about today?”. Pro Whitty:

“…the basis for this is, in my view, scientifically weak, probably dangerously flawed, operationally impractical, and, I think personally, ethically a little difficult.”

Prof Whitty goes on to ‘tear apart’ the GB Declaration but in doing so reveals his biases and misunderstandings.

“The biggest weakness in this is that it starts from the thesis that inevitably herd immunity will be acquired if you leave things long enough. That is not the case for a very large proportion of the most important diseases in the world… You do not [get Herd Immunity] for malaria; you do not for HIV; you do not for Ebola… The idea that this is an inevitable thing, which is a fundamental tenet to this, is simply incorrect.

The inability to develop Herd Immunity for Covid is an opinion and goes against scientific fact. He mentions HIV, Malaria; and Ebola but these are fundamentally different pathogens. To create immunity, you first have to survive the virus. By definition, if you have survived, you are immune – otherwise you’d be dead. Ebola has an IFR of 70%, not the 0.5% of Covid. There is a mathematical formular that links the Herd Immunity percentage to the R0 (the ‘natural’ R#) of a virus.

Both Ebola and Covid have a similar R0 ≈2, so the Herd Immunity percentage for both would be around 60%. Unfortunately, Ebola kills 70% of its cases, so it’s impossible to reach Herd Immunity due to fatality numbers, not because immunity is medically impossible. Immunity to Ebola is actually possible (Ebola survivors still have immunity after 40 years (Nature, 2017)).

Looking at HIV, as you cannot survive HIV, you cannot become Immune, as such Herd Immunity is impossible. The same can be said from Malaria. None of the viruses he mentions can be recovered from, but Covid 19 can be, it has sufficiently low R0 (2.5) to only require a 60% population exposure, and a sufficiently low IFR (0.5%) to make Herd Immunity feasible.

“We do know that with this particular infection you can get some degree of immunity early on - that is reasonably clear - but we do not know how long that lasts for. Even if it could be achieved over time and people maintained that immunity for long enough, you would need to get up to probably 60% to 70% of the population, which we are a very long way short of. So, for all of those reasons, that bit of it is wrong.”

Again, this is misleading. He’s right that only ≈60% of the population is needed for Herd Immunity to work, but the R# would reduce as exposure increases, meaning a lowering of NHS demand. Full population (to 60%) exposure would happen in approximately 3-6 months (based on an R0 of 2.5 and the virus’s gestation period, etc). Reports of antibodies dropping after 3-month is irrelevant, they are means to. The body only produces the antibodies it needs at any given moment, but it retains the ‘memory’ of how to produce more. In addition, inherent immunity through T & B Cells may well increase the UK’s baseline immunity, meaning fewer than 60% need to be infected. In terms of current exposure levels, the UK is between 11-35% immunity; 60% is not that far off.

On the practicalities of targeted shielding, Prof Whitty says:

“The idea that you can do that and do it for year after year is simply impractical. We have been asked this multiple times - and Patrick might wish to talk about how SAGE has looked at this - but everyone who has looked at this says what a great idea until they look at the practicalities. How are you going to look after people in nursing homes? How will you look after people in hospitals? How will the elderly meet their grandchildren?”

Prof Whitty fails to comprehend that this is not a year-on-year requirement, and in fact the measures would have been completely removed by now had a GBD-type approach been adopted in April. After 60% population exposure, the disease becomes endemic and becomes an accepted part of UK life, as such no additional measures would be required. In terms of the actual protection, a clear set of voluntary measures combined with financial and practical support would suffice (see here for further commentary). There would be no need to do anything more than that which the Lockdown/Shielding already does. The key difference being that the ‘healthy’ are not impacted by the restrictions and allowed to get the virus and generate the immunity.

“It is practically not possible, and it would make an assumption that very large numbers of people would inevitably die as a result of that decision. You would have to get all the people up to that 60% naturally infected, and, for something that has a 0.5% to 1% Infection Fatality Rate, that means a very, very large number of people - if you think of the 60% or 70% of the UK population - would inevitably die as a result unless you could achieve this perfect identification of everyone who is going to get ill, which you cannot, and entirely isolate them for several years, which you cannot. Other than that, it no doubt has some merits.

Prof Whitty becomes flippant in his commentary here and again misses the fundamental point of the GBD. A quick look at the maths:

Population x Herd Immunity % x IFR = deaths

If we have gradual exposure to the UK demographic (eg through Lockdowns and Restrictions, then the deaths using the ‘all population IFR’ result in:

66.5m * 60% * 0.5% = 80,000 deaths

But if we limited exposure to the healthy, we can use the ‘under 70’s IFR’ of 0.02%:

66.5m * 60% * 0.02% = 20,000 deaths

So, the GBD will see far fewer deaths than any natural spread of the virus through the population. In the absence of any vaccine, a gradual spread through the population is the only outcome, it’s not a choice but an inevitability.

“I share the view with the director general of the World Health Organisation that, given all of those, to have this as an element of policy would be ethically really difficult.”

The ethically difficult decision is continuing to demand more deaths due to SAGE/UK Gov being too scared to implement a policy that would drastically reduce deaths. Vallance added:

“We published a paper outlining exactly that a few weeks ago as the argument why this really is not a good idea and why the argument has some fatal flaws. There are two others that I would add. First of all, I completely agree that you get to an attempt to herd immunity through vaccination, if you can, but that is not always possible either.”

If Herd Immunity through vaccination is not the plan, what exactly is the plan, when does this all stop? If it is when ‘treatment is better’ than that’s a tacit admission that they are planning to let the virus pass through the population without any controls to limit the exposed demographic at all.

Q1563When asked Prof Whitty highlights some of the other treatments that may reduce deaths.

Q1564No comment

Science and Technology Committee

Oral evidence: UK Science, Research and Technology Capability and Influence in Global Disease Outbreaks, HC 136

Tuesday 3 November 2020

Ordered by the House of Commons to be published on 3 November 2020.

Watch the meeting

Details of the Session

Members present

Greg Clark (Chairman)

Aaron Bell

Dawn Butler

Chris Clarkson

Katherine Fletcher

Andrew Griffith

Darren Jones

Mark Logan

Carol Monaghan

Graham Stringer

Zarah Sultana.

In attendance

Jeremy Hunt

Lord Patel

Questions

1433 - 1564

Witnesses

Sir Patrick Vallance, Government Chief Scientific Adviser

Professor Chris Whitty, Chief Medical Officer for England.

Written evidence from witnesses:

Nil

Examination of witnesses

Witnesses

Sir Patrick Vallance

Professor Chris Whitty.

Chairman: This is a special hearing of the Committee to consider the evidence and advice that informed the Prime Minister’s announcement of new restrictions that he made on Saturday evening and that will be debated in Parliament tomorrow.

I am very grateful to the Government’s Chief Scientific Adviser, Sir Patrick Vallance, and the Chief Medical Officer, Professor Chris Whitty, who agreed straightaway to the Committee’s request to appear before it today.

I welcome to the Committee Jeremy Hunt, who is Chairman of the Health and Social Care Committee, to Darren Jones, who is a member of this Committee but also chairs the Business, Energy and Industrial Strategy Committee, and Lord Patel, who is Chairman of the House of Lords Science and Technology Committee.

Perhaps I may start, before turning to colleagues, with some questions to Sir Patrick. Without the proposed new measures that were announced on Saturday to be debated tomorrow, how many deaths a day from Covid do you expect the peak to be this winter?

Sir Patrick Vallance: It is very difficult to put numbers on an exact peak and when that occurs. What we can see, though, is that the R remains above 1 everywhere. The epidemic continues to grow. If you take the six-week forward projection, that is the part of the modelling where you are going to get greatest reliability, because, in any model that relies on data, theory and assumptions, the further you go out the more unlikely it is that you get the number exactly right. As you come nearer, you get more accuracy, and the six-week projections that the SPI-M modelling groups have been looking at for the past number of weeks have turned out to be pretty good in tracking what happens.

They look as though, during that period, if nothing changed - that is important, because things clearly are about to change - you would expect the number of hospitalisations to breach the first wave number probably towards the end of November. You would expect the number of deaths, potentially, to equal the first-wave numbers somewhere in mid-December. That is what they would look like. That is the range you think of in the trajectory if nothing changed from where it was now.

Q1433. Chairman: From where it was now - so before these measures had been introduced.

Sir Patrick Vallance: Yes.

Chairman: Can you explain how this relates to the chart you presented, which had some different curves from different research groups, about which there has been quite a lot of interest?

Sir Patrick Vallance: Yes. When that was presented on Saturday, I said that those were scenarios that were put together to try to look at what a new, reasonable worst-case scenario might look like. They are from a couple of weeks ago. They are longer-term modelling, which come with all the caveats in terms of accuracy.

You can see that different groups have done those scenarios and have made assumptions. The assumptions they were given at that point were that the R would be between 1.3 and 1.5, and that it might go up by 10% during the winter. They modelled on that basis. You can see that the different groups came up with different peaks as a result of that. That would be to inform a reasonable worst-case scenario.

Another example might be, if you go back to June, that the Academy of Medical Sciences did a reasonable worst-case scenario for the winter that came up with higher numbers at that point.

That curve was then to lead into the six-week projection, which are the ones that carry more validity in terms of the numbers. Again, it is still a model, so you just project forward for that period and you see that, quite quickly, we reach similar numbers as in the first wave. The six-week ones are integrated across all the models.

Chairman: Is there a consensus view in SAGE through the modelling group on when the peak will be, assuming these new measures do not come in, and what level it will be?

Sir Patrick Vallance: The consensus statement of six-week, medium-term projections is a consensus from all the modelling groups taken through SPI-M projected forward over that six-week period. The other graph would come into a reasonable worst-case scenario consensus if that is what the Civil Contingencies Secretariat want, and they would commission that. At the moment, it is not a consensus. That is independent groups having modelled against a series of assumptions.

Chairman: So SAGE has not come to a consensus view on what the modelling projections would be.

Sir Patrick Vallance: For the six weeks, yes; beyond that, no.

Chairman: Turning to the NHS capacity, without the proposed measures being taken, when do you expect the acute bed capacity of the NHS to be used up through Covid patients?

Sir Patrick Vallance: I may bring Chris in on this. Clearly, what the SPI-M group can do is model forward the epidemic. Those are then provided to the NHS. Clearly, the NHS owns capacity modelling because it knows what the capacity is and we do not have the insight into the exact bed capacity.

The numbers, if you look at where the six weeks take you, suggest that the first-wave peak equivalent is somewhere at a national level towards the end of November, with greater pressure thereafter, but that will not be even across the UK. Some hospitals are clearly under pressure now; others will be under pressure later. That is an average. It is not expected that everyone will follow that curve.

Chris, you may want to say something about that.

Professor Whitty: It is important to say that a lot of the advice that I have given is not based on significant forward modelling. It is based on what has happened and what is observable. If you look at the number of in-patients - I am using management information service data, which is broadly accurate for England - on 7 September there were 536 cases. By the time you get to the beginning of October, it is over 2,500. As of today, it has breached 10,000 people in hospital. You do not need too much modelling to tell you that you are on an exponential upward curve of beds.

This is completely repeated in the ONS data - backward-looking data - looking at incidents over time, which has followed a very clear upward trend. We know from all epidemics that you get a doubling. Epidemics are either doubling or halving. This is currently doubling. It is doubling at slightly different rates around the country, although bits of the country are starting at different stages.

There are two things to say about your question on beds. The first is that the starting point - how full they are now - is currently very variable. Some hospitals, particularly in the north of England, have reached levels of Covid occupancy higher than they had in the first wave. Our worry about those areas is that although it looks as if the R in the community is flattening but has not fallen below 1 as far as we can see, it is still going up. If it carried on going up from this very high base, they would get into serious trouble with in-patients very quickly.

There are other bits of the country - for example, the south-west - where the rate of increase is faster than in the north now and bed capacity is lower, so, although they look further away at the moment, they could hit difficulties relatively quickly.

To make an obvious point, I hope, to this Committee - I think it is worth it for those watching - there are several different barriers you go through in hitting capacity in the NHS. The first thing we are already having to do in some areas is cancel non-urgent elective care. Then you start to impinge on urgent but non-emergency care. Then you get into acute care being constrained and, finally, into all the intensive care capacity being used up. That happens in sequence, but we are already seeing parts of the country having to cancel non-urgent emergency care.

If this continues, people worry, rightly, about all non-Covid care being affected. This argument is slightly the wrong way round. The way you prevent those services being impinged on and, potentially, being slowed right down or even in some cases cancelled is to keep the Covid rates down. If you do not, that is going to erode the capacity of the NHS to do not just Covid care but non-Covid care.

Chairman: Specifically, one of the slides that Sir Patrick presented on Saturday looking at projected bed usage showed that without these new measures the spring peak would be exceeded on 20 November or thereabouts. With the extra beds it would be a few days later, and, even with the extra capacity that comes from cancelling operations, that would be early in December. Does that reflect your joint view of what would happen to hospital capacity usage without these measures?

Professor Whitty: There is some evidence of some slowing, particularly in the north-east and possibly in the north-west, that might push that out in time, but until you start to see rates falling - it is a matter of timing as to which week you get into for these various stages - and they do not happen all at once or all at the same rate throughout the country, the trouble about things that start doubling is that you move from very small numbers to very large numbers surprising quickly.

Chairman: As is clearly understood, you are advisers rather than decision makers. You give advice to Ministers. Is it your joint view that without these measures there is a serious risk, to put it no stronger than that, that the NHS intensive care capacity would be overrun?

Sir Patrick Vallance: This slide is from the NHS. This is the NHS view of what would happen based on the SPI-M model.

Chairman: Do you agree with it?

Sir Patrick Vallance: Yes, given the caveat that it is a model.

Chairman: As the Chief Scientific Adviser to the Government and the Prime Minister, your advice would be, based on this modelling, that there is a serious prospect of the intensive care capacity of the NHS being overrun within the period to which this graph refers.

Sir Patrick Vallance: If nothing is done, yes.

Chairman: We come to the importance of the inquiries into these forecasts. Accepting that Ministers decide and advisers advise, in practice, if the advice from advisers to the Prime Minister is that the capacity of the NHS is likely to be overrun within weeks, that is quite difficult advice to gainsay, is it not? That is why there is an interest in understanding the basis of the advice. It is not optional advice in that sense, is it?

Sir Patrick Vallance: That was the forecasting from the NHS. That is what they said.

Chairman: It is also what you said.

Sir Patrick Vallance: Yes. It is what we say from the modelling. As I said, we cannot deal with NHS capacity. I do not have insight into NHS capacity.

Chairman: But your advice to the Prime Minister and the Government, based on NHS data and the modelling data, was that this is a serious prospect and a serious risk.

Sir Patrick Vallance: Yes.

Professor Whitty: It is a serious risk but is not inevitable. The actions being taken by people are already having an effect. Our view is that it is just a matter of time. Once the R is above 1, it will keep on going up and the question is only how long.

Chairman: Do the forecasts and projections include the impact of the tiered restrictions that began in most parts of the country on 14 October?

Professor Whitty: They will not yet be feeding through, in my view, fully into the numbers, but they will push them out in time. They would not change. It is not a question of whether, but it might be a question of when. The only part of the country at the moment where there is realistic evidence that the numbers have flattened where the R is approaching 1 is, probably, in terms of regions in the north-east. There may be some smaller areas elsewhere, but it is still, as far as we can tell, going up, albeit at a much, much lower rate. This is the view of the local directors of public health as well as the NHS view. This is a quite widely held view.

What you are indicating, and rightly, is that putting exact dates on these things is almost impossible because what the Government do - it is also how people themselves respond - is they see a problem locally and neither Patrick, myself nor anyone who is advising Government would say, “This is definitely going to happen on this date.” People who give that degree of certainty have not understood how modelling of this sort with scenario uncertainty properly works.

The inevitability, if your R remains above 1, even if it is by quite a small amount once you have reached a high level of bed usage, is that you have very little headroom. So quite a small R can take you from just about coping to not coping. We are looking forward in a bad way to the fact that the most difficult time for all respiratory viruses, as we all know, is during the winter months. We have not fully got into them. So the chances that things are likely somehow to improve without action between now and the next few months are quite low. If you are giving advice to Ministers, that has to be the advice you give.

Ministers then have to make decisions not just on that advice. They have to use multiple other things that have big social and economic impacts. Ministers have to take them into account. It is right that elected Ministers make those decisions. It is one strand of advice. I believe quite strongly that it is important that these deeply difficult societal measures fundamentally are decided by Ministers.

Chairman: I understand that. The point I have made is that, if the NHS can cope and things can be accommodated, there are decisions that Ministers can make about the impact on the economy. It is much more difficult to make choices and decisions if the bottom line is that people are going to be dying in hospital car parks.

There is a specific issue that I want to explore. I quite understand that specific dates are not possible to ascribe to models - it is the shape of it that counts. Given the presentation and the analysis that was made that justifies action that the Houses of Parliament are considering this week - the information and presentational analysis was given on 31 October - surely it would be reasonable for that analysis to include an assessment of the prospective impact of measures that were decided many weeks before and indeed became operational on 9 October. Why is the prospective experience of measures taken and implemented on 9 October not factored into the analysis that you shared with the country on 31 October?

Sir Patrick Vallance: It is to the extent that the medium-term projections that were approved were approved on Thursday, so they are the latest estimate from SPI-M on the medium-term projections taking into account all the data that they have up until that moment.

Chairman: So they include an assessment of the impact of the tiered restrictions in different parts of the country.

Sir Patrick Vallance: As far as those tiered restrictions have had their impact at that point. They were looking on that date at the data they could have at that moment, but those data, of course, are also backward looking. They are not going, necessarily, to be able to project everything that happens as a result of changes that are not yet known.

Chairman: We know what those restrictions were. The restrictions were chosen, presumably, on the basis that they were going to have an impact on the prevalence of hospitalisation, deaths and the capacity of use of hospitals. You must have an assessment of what they hoped to achieve. There are at least two weeks, perhaps more, of data on what they were achieving. Were they factored into the projections of the impact on the NHS that was presented on 31 October?

Sir Patrick Vallance: They are factored in. The forward projection is the best estimate by the modelling groups of what would happen going forward.

Chairman: Including the impact of the tier restrictions.

Sir Patrick Vallance: If you look at the performance of the six-week projections over the past month, the actual data has tracked very closely to the projections, suggesting that they are pretty good in being able to look forward and taking into account what would happen, but they cannot be perfect because no model ever is.

Chairman: What has been the modelled impact of the tiered restrictions that were introduced early in October? By how much have they reduced the number of modelled deaths? I refer to Professor Whitty’s point: how far back they have pushed the prospective peak?

Professor Whitty: It is difficult to be absolutely confident about how far their effect has gone. I am confident that tier 2 has had an effect and that tier 3 has had a bigger effect. The communities in the north and the midlands, in particular, where most of these are - London is in tier 2, as are some parts of the east of England - have responded remarkably to this. Because of that, I am confident that the rates are substantially lower than they would have been had those activities not happened. The early indications are that this has not achieved getting the R below 1. It has brought it much closer to 1 but it is still doubling over a longer period. It is not possible to put an absolutely accurate fix on that, unfortunately. We now have hospitals, such as in Liverpool, that are above their previous peak. It does not take much of an increase from that to run into quite serious trouble. On the ability to hang on and say, “Let’s wait a couple of weeks; let’s just see what happens,” the problem is, as you know, that the people who are in hospital now were infected several weeks ago, so there is quite a long lead time between taking an action and having an effect on reducing the number of people going into hospital, into intensive care and, sadly, in some cases dying. Therefore, if you wait too long, you have baked in a very large backlog of things where the rates are still going up. We do not, in my view, have clear evidence at this point that R is below 1 anywhere with significantly high rates. That is a reality that my NHS colleagues in the north of England would say they recognise.

Chairman: I understand that lagged effect on admissions and, ultimately, deaths, but in Liverpool, for example, which you cited, the peak level of positive tests was around the time of the imposition of tier 3 - around 9 October - where there were about 3,500 positive tests a day. That is the seven-day rolling average. The most recent seven-day rolling average, which has come down consistently since that peak, is about 1,900 - falling towards about half that rate.

Does that indicate, in your view, that the tier 3 restrictions are working, and has that been fully captured in the modelling that has been put forward to justify the new national restrictions?

Professor Whitty: Looking at the data, particularly in the north of England - I tend to look backwards at data as I am, for exactly the reasons you give, Chairman, very cautious about short forward projections; I am much more interested in how the data is playing out in real time and, therefore, the immediate future - we are seeing that the rates, particularly in younger people, have fallen. That is a combination of, probably, some slight reduction in uptake and some levelling off and, possibly, a reduction in positivity rates. There is a real effect and an artificial effect, if you see what I mean.

We are not seeing that reliably in the older age bands as it is moved up through the age bands. That is important because the rates falling in people in their 20s will have remarkably little impact on the NHS. A few people in their 20s get into serious trouble. More may have long-term morbidity problems, not necessarily getting into hospital but have a group of syndromes that are currently known as long Covid, but the rates are still steadily tracking up. All the data that I have seen is in the older age groups, who are the ones likely to translate into hospitalisations, ICU cases and deaths.

It would require an extraordinary degree of confidence that the overall data were translating through to say the incidents are still going up in the age groups who are most vulnerable to having severe outcomes and ending up in hospital and, in some cases, having very bad outcomes. It is that age differential that I do not think is necessarily captured in the headline figures. If people who are spending their entire time looking at hundreds of pages of data see the headline and think it is going down, which is reassuring, although not necessarily going down overall, but the rate of increase is going down, there is this quite marked age differential where it is the young adults where the reduction is most marked.

Chairman: So you believe that the fall in positive tests in places like Liverpool - they are quite marked in the last few weeks - is not reflected in the prevalence among older people.

Professor Whitty: Correct. This is a differential effect among different ages. My hope is that it is now levelling off in the older ages as well. There is some evidence that that may begin to happen, but it is certainly not to the point where you can reliably say, “I know the models show this but I think it may be going lower than that,” but that is not what we are seeing in these older age groups. I would be delighted, obviously, if the answer was that they were going down faster than the data currently are showing. There is always a bit of a data lag. If that was the case, that would be very good news, but it would be very imprudent to work on that basis.

Chairman: The implication is that the local lockdowns and tiered measures are not working for older people.

Professor Whitty: The implication is that all the tiering has slowed things down from where it would have been otherwise. That would be my judgment as to where we are: more in tier 2 than in tier 1, and more in tier 3 than in tier 2.

That is due to the remarkable work of individuals taking quite difficult social decisions for quite long periods in many of the towns in the north. We should not forget how long some of them have been in these measures. There is no evidence, in my view, at this point that in the older age groups the R is now reliably falling below 1. It may be in some places approaching 1 and, therefore, the doubling time is going out in time. That is not the same as the doubling time turning to a halving time, which is what you want to see.

Chairman: It is precisely for that reason, Professor Whitty, that people who have suffered restrictions for a long time would want to be reassured that their experience has been reflected in the model and that we are not justifying a national lockdown without reference to the experience that they have gone through.

Will you publish the NHS capacity usage model that lies behind these figures, because it is such a pivotal one for the measures that are taken?

Professor Whitty: The data that I was talking about were not NHS data. Those were the JBC test and trace data. They are not my data, but I do not see any reason why anyone would not want to publish data of this type.

Chairman: Will you write to the Committee in the next few days with the details?

Professor Whitty: As I said, it is not my data to release. From my point of view, it should be openly available. Almost all the key headlines are openly available in almost all areas through PAT and other routes.

Chairman: As the Chief Medical Officer, I am sure you have influence.

Professor Whitty: All I am doing is trying to avoid promising something that I cannot guarantee to deliver. I am pretty confident that I can, and I want to because I wish people to see that I am very strongly in favour of people seeing the data. I am very strongly in favour of it.

Graham Stringer: Following up on your points about infections increasing in the elderly and more vulnerable people, which is the key criterion? Is it the R figure or the rate of infection in elderly people?

Professor Whitty: The rate of infection in elderly people - the number of people infected - tells you what is going to happen in a small but important proportion because the total numbers are very large, with a significant number of people having severe effects. What has happened in people over the age of 60 is the strongest predictor of what will happen in the NHS. For the sake of argument, of course, it is much greater in those in their 70s and much greater again than those in their 80s. There is not a cut-off. It is a log-linear curve.

If R is above 1, it is doubling, and it is halving if R is below 1. At this point in time, all around England, R is either above 1 or tending towards 1 but not falling at this point overall. This is the figure that comes out of SPI-M. Patrick is in a better position to talk about that, but the R is a summary figure - it is either rising or falling. That is the key question. The R, in a sense, is a reflection of that.

Graham Stringer: I understand that the R is a composite figure. If R is at 0.8 or 0.75, but there are many infections among elderly people and hospitalisations, which is the key factor in your recommendations?

Professor Whitty: In the immediate term, the number of people currently infected is key, but the R will tell you that you have this number of infections now, but if it was 0.8 - I would be delighted if it was 0.8 - that would tell me that if I look forward two, three or four weeks the numbers of people who are new incident cases would be going down. We would be back to the numbers halving rather than doubling. Currently, they are doubling in most places.

Graham Stringer: Sir Patrick, Professor Whitty said that for anybody familiar with modelling it was clear what was going in. However, it is fair to say that the vast majority of people in this country are not familiar with modelling. Was it sensible or fair to put forward the graph with 4,000 deaths a day with or without the caveats? Pictures tell a much more powerful story than numbers. That will have frightened many people around the country. Would it not have been better both to give the source data and explain it in great detail, not just that it was modelling, and that the figures that had gone into it were six weeks old?

Sir Patrick Vallance: I positioned that - if it did not come across, I regret that - as a scenario a couple of weeks ago based on an assumption to try to get a new reasonable worst-case scenario, and that those figures, therefore, were not as reliable as the six-week figure, which I spent time talking about. Those figures were done by major academic groups based on those assumptions. In the spirit of trying to make sure that things are shared and open, they are the things that we have seen. It is important that people see that.

Graham Stringer: I do not think people see that. If you look at the serious broadsheet press and the more popular tabloids, you see that people have been horrified in the way that was presented. They thought it was a biased way of presenting it and not at all clear. You must realise that, if you put a graph up saying 4,000 deaths a day, that is going to be the message that the vast majority of people take home. Do you regret that at all?

Sir Patrick Vallance: The aim of the presentation was to try to get as much information as we could to the public. The six-week projections were important in terms of their reliability. Those were models for the reasonable worst-case scenario, and people have been interested in the reasonable worst-case scenario. They were modelled at the time to try to project that. They came from significant academic groups. They are no more than a model of the reasonable worst-case scenario based upon assumptions. The further the models go out, the more unreliable the numbers are and the more it becomes a qualitative exercise to look at the shape of things. It is important that people understand and see what is being looked at by the modellers who believe that these things are important to have in the reasonable worst-case scenario.

Graham Stringer: You do not think that you just frighten people who do not have your scientific background and understanding of models.

Professor Whitty: I hope not. That is certainly not the aim. In a sense, we went through this a bit on 20 or 21 September when we said that we thought things could be headed towards 50,000 cases per day if we had a doubling - again, it was a scenario, not a prediction - and deaths might reach 200. The argument was that those slides were meant somehow to scare people, they were not. They were there to give a scenario. As it happened, the numbers turned out to be very close to that by the time we got there. It is very difficult to project forward in a way that does not inevitably lead to a problem of, “Is that real?” No, it is not real. It is a model, but it is what we need to understand because this is a disease that is spreading, like all epidemics, in a way that will affect us in weeks to come but is not felt today. There is a balance between trying to explain what may be coming, basing things, as Chris has said, as far as possible on what data you have today, which again is why things were presented as they were, to say, “Here are data from today and what is happening in hospitals today,” but giving an illustration of what may happen in the future, which is an important part of this. The tendency otherwise is to wait and to say, “We will find out in a few weeks’ time,” by which time you have baked in another three or four weeks of cases.

Graham Stringer: It seems to me that there are two reasons for having a lockdown: to save lives and buy time so that you can improve test and trace in all parts of the service. In terms of your recommendations, you are very clear in your models, the information you provide in the models and what numbers you want to present to the Prime Minister and to the public. You always add a caveat that there are economic consequences and health impacts, but it is never quantified. The last time you were here you told us of the paper on 8 April, which was a quantification of some of the deaths that will be caused by the failure to treat cancer - I am not going to go through the whole list - and the consequences of poverty on morbidity. Why do you not present both sides of the equation in numbers?

Sir Patrick Vallance: Chris may want to come in on this. The paper you referred to was a paper that we asked for from ONS actuaries, and the other was to try to look at the overall effect. That was a very important paper and that is being updated.

Graham Stringer: And the Department of Health.

Sir Patrick Vallance: That is being updated, and Chris may want to say more about that.

It is very clear that SAGE exists to provide the science advice. The Treasury and the Cabinet Office bring in the other parts of the equation, particularly on the economy. I do not think it is right to think that SAGE would be the place that you integrate all of this and come out with a single number. We have a particular part of this to look after and the rest needs to be integrated at Cabinet Office level. Ultimately, of course, Ministers need to look at all those other points.

It is an interesting question. The science advice is very clearly in the public domain. It is very clearly public; you can see it and question it. The other advice, of course, is less visible, so it is more difficult to answer those questions.

Graham Stringer: But the advice is lopsided, isn’t it? I would be interested in seeing the updated paper of 8 April, which, from memory, projected more than 200,000 deaths not over a year but over a period of time. I think the public would be very surprised to see that that was the other side of the equation. At the very least, I can accept that you need economists to do it and all sorts of other specialists, but do you not feel a responsibility to make sure that people know there is another side to that equation?

Professor Whitty: Could I add something? I think there is a danger that people watching will have a misapprehension. Most of the additional deaths stack up because you don’t deal with Covid. Basically, there are four different ways in which this causes mortality. I will go through them. This is a really critical point that has been wholly misunderstood in some areas. Direct deaths from Covid is easy to understand. I agree with that.

The second group, which hopefully we will not get to, are deaths from emergency services being overwhelmed. We did not have that in the first wave and we have every intention of trying to avoid that in the second wave.

The third group is things that would happen: because of Covid putting pressure on the service, you have to cancel elective and other urgent care. Those deaths might be cardiovascular. In the medium term, that might be cancer. Those are on the Covid side of the equation.

Then you have some that were around the lockdown itself, which are things like reduction in air pollution on the good side, and an increase in mental health problems on the bad side.

The final ones, which are very important, are the economic ones: counterintuitively, the immediate effect is not negative but in the long term that is very important. That is the bit that is on the other side of the equation. I have always said that clearly. If you are in public health, caring about increasing deprivation is central to what you do. It is absolutely critical. I have always tried to say that that is the other side of the equation.

The cancer and cardiovascular deaths are on the Covid side. If you don’t deal with Covid, those are going to get worse.

Graham Stringer: I am running out of time. I understand the point that you are making that, because of the pressure of Covid, some of those services are reduced. Some of those services were reduced because a service was withdrawn, but not directly because of Covid. That is a more complicated equation. My point to Sir Patrick is: should not that somewhere in the system be put together, whichever side of the equation you put it on? Will you do that?

Sir Patrick Vallance: Again, you are right. It needs to come together with the economic analysis. That is not something that takes place in SAGE, nor should it take place in SAGE. It needs to come together in the Cabinet Office.

Chairman: You have been very good at publishing at the request of the Committee and others the papers and evidence that SAGE has considered. There is a bit of a time lag there. I think this week shows it would be good to have the real-time information. Can you arrange for that economic analysis to be pu